Patient Safety Indicators 2012

Center for Health StatisticsTexas Health Care Information Collection

The Patient Safety Indicators (PSIs) are a set of indicators providing information on potential in hospital complications and adverse events following surgeries, procedures, and childbirth. The PSIs were developed by 3M™, after a comprehensive literature review, analysis of ICD-9-CM codes, review by a clinician panel, implementation of risk adjustment, and empirical analyses.

The PSIs can be used to: help hospitals identify potential adverse events that might need further study; provide the opportunity to assess the incidence of adverse events and in hospital complications using administrative data found in the typical discharge record; include indicators for complications occurring in hospital that may represent patient safety events; and, indicators also have area level analogs designed to detect patient safety events on a regional level.

In-hospital deaths per 1,000 surgical discharges, among patients ages 18 through 89 years or obstetric patients, with serious treatable complications (deep vein thrombosis/ pulmonary embolism (clotting or blockage of blood vessels that cause other complications), pneumonia (inflammation of the lungs caused by bacteria, virus or irritating drug or substance), sepsis (inflammation of many areas of the body generally due a infection by bacteria which may cause death), shock/cardiac arrest (a condition where not enough oxygen carrying blood can be delivered to the body tissues or organs and may lead to death or destruction of the tissue) or gastrointestinal hemorrhage/acute ulcer (a conditions where there is a injury or destruction of normal tissue in the stomach and intestines). Includes metrics for the number of discharges for each type of complication. Excludes cases transferred to an acute care facility.

Iatrogenic pneumothorax (accidental puncture of the lungs by medical personnel or devices) cases (secondary diagnosis) per 1,000 surgical and medical discharges for patients ages 18 years and older. Excludes cases with chest trauma, pleural effusion (fluid surrounding the lungs), thoracic surgery (surgery involving the organs inside the chest are), lung or pleural biopsy (a procedure to remove a piece of the lung or the outer covering of the lung for further examination and testing), diaphragmatic surgery repair (a procedure to repair the primary muscle for breathing) , or cardiac procedures (heart procedures); cases with a principal diagnosis of iatrogenic pneumothorax; cases with a secondary diagnosis of iatrogenic pneumothorax present on admission; and obstetric cases.

Perioperative hemorrhage (bleeding from tissues around the surgical site) or hematoma (a condition where the tissue swells up with blood making a nodule in the tissue) cases with control of perioperative hemorrhage, drainage of hematoma, or a miscellaneous hemorrhage- or hematoma-related procedure following surgery per 1,000 surgical discharges for patients ages 18 years and older. Excludes cases with a diagnosis of coagulation disorder (a condition that affects the clotting of tissue); cases with a principal diagnosis of perioperative hemorrhage or hematoma; cases with a secondary diagnosis of perioperative hemorrhage or hematoma present on admission; cases where the only operating room procedure is control of perioperative hemorrhage, drainage of hematoma, or a miscellaneous hemorrhage- or hematoma-related procedure; and obstetric cases.

Postoperative respiratory failure (secondary diagnosis) (when the patient stops breathing), mechanical ventilation (a procedure of using a device to assist the patient in breathing), or reintubation (a procedure to put another tube into the air passage way) cases per 1,000 elective surgical discharges for patients ages 18 years and older. Excludes cases with principal diagnosis for acute respiratory failure; cases with secondary diagnosis for acute respiratory failure present on admission; cases in which tracheostomy (a procedure to create a hole in the air way in the lower part of the throat to insert a tube for breathing or administering other medications) is the only operating room procedure or in which tracheostomy occurs before the first operating room procedure; cases with neuromuscular disorders (problems with nerves and/or muscles), laryngeal (the tissue that allows you to speak) or pharyngeal (the soft tissue at the back of the mouth and nose) surgery, craniofacial anomalies (birth defects of the head and face) that had a procedure for the face, esophageal resection (a procedure to remove part of the tissue where food travels down from the mouth to the stomach), lung cancer, or degenerative neurological disorders (conditions where the nerves are becoming less effective); cases with a procedure on the nose, mouth, or pharynx; cases with respiratory or circulatory diseases (conditions involving the heart and blood vessels); and obstetric discharges (female patients which are being treated or examined for condition involving their reproductive organs).

Postoperative sepsis cases (secondary diagnosis) (patients which develop inflammation over many parts of the body from an infection after a surgery) per 1,000 elective surgical discharges for patients ages 18 years and older. Excludes cases with a principal diagnosis of sepsis, cases with a secondary diagnosis of sepsis present on admission, cases with a principal diagnosis of infection, cases with a secondary diagnosis of infection present on admission (only if they also have a secondary diagnosis of sepsis), cases with an immunocompromised state (a condition where the body’s defense mechanism are decreased due to a non-normal bacteria, virus or other substances comes in contact with the body), cases with cancer, obstetric discharges (female patients which are being treated or examined for condition involving their reproductive organs), and cases with stays less than four (4) days.

Accidental punctures (when some foreign substance actually goes into a tissue of the body) or lacerations (when tissue is torn by some forceful event, NOT a cut from a sharp object) (secondary diagnosis) during procedure per 1,000 discharges for patients ages 18 years and older. Excludes cases with accidental puncture or laceration as a principal diagnosis, cases with accidental puncture or laceration as a secondary diagnosis that is present on admission, spinal surgery cases, and obstetric cases.